A Farm road near Snowville, Ohio in Meigs County. (Zoe Cranfill)
Out of Reach
How rural families in Ohio deal with a lack of maternity care.
By: Emma Reed and Zoë Cranfill
In rural Ohio, where maternal healthcare facilities are few and far between, families face an uphill battle to receive care. Pregnant individuals are forced to travel hours for a routine check-up or rush to hospitals in the face of labor complications. These families are faced with an alarming reality: They live in a maternity care desert, where prenatal and delivery services are out of reach. This term was created by March of Dimes, a non-profit organization dedicated to improving the lives of mothers and babies.
​For many women, this is their regular. Their options
are few and far between; some women drive hour-long trips to the nearest hospitals for prenatal care. Similarly, families decide to go to Women, Infants, and Children, WIC for pregnant, breastfeeding, postpartum, and children under five years old. Others prefer to use Wellness on Wheels in Vinton County, which is soon expanding to other counties. Many families have decided to go back to the basics and use midwives. ​
Kristina Muehlhauser, a 37-year certified professional midwife, carries Valerie, a newborn baby, away from her mother and father, Megan and Patrick Mascari, after cutting Valerie’s umbilical cord at their home in Circleville, Ohio. (Emma Reed)
Midwifery
In other parts of the world, midwifery is normal for births. You are expected to have your child at home or attended by a midwife in a hospital. According to the American College of Nurse-Midwives, this is a different case in the United States, where only 10% of births are attended by midwives in Ohio. Emily Neiman is a Clinical Instructor of Practice at Ohio State University College of Nursing in the Nurse-Midwife Program. She has been a practicing midwife for 15 years in the Columbus area. Neiman said, “It's a growing profession. It's just really
interesting because we do, you know, in countries in Europe midwives are the standard of care. They take care of the majority of patients. You don't see a doctor unless something is wrong. You're having some kind of issue or a complication with your pregnancy or birth and it's just really the norm that you have these experts in normal who take care of the vast majority of people who are normal.” This thought of returning to normal is bringing women in Southeast Ohio help.
"It's a growing profession. It's just really interesting because we do, you know, in countries in Europe midwives are the standard of care. They take care of the majority of patients. You don't see a doctor unless something is wrong. You're having some kind of issue or a complication with your pregnancy or birth and it's just really the norm that you have these experts in normal who take care of the vast majority of people who are normal. "
- Emily Neiman, Clinical Instructor of Practice at Ohio State University College of Nursing
(top left) Kristina Muehlhauser takes the heartbeat of Carolyn Weaver, a pregnant Mennonite woman, in Russellville, Ohio. (Zoë Cranfill) (top right) Kristina Muehlhauser unloads her car as she prepares for a prenatal visit at Russellville, Ohio, Carolyn Weaver’s, a pregnant Mennonite woman. (Zoë Cranfill) (bottom left) Kristina Muehlhauser measures Megan Mascari’s stomach at Kristina’s New Salem, Ohio home. Kristina makes prenatal appointments at her home on Sundays and Thursdays, while she travels to families' homes on the other days. (Zoë Cranfill) (bottom right) Kristina Muehlhauser, a 37-year certified professional midwife, checks Megan Mascari's dilated pregnancy status at her South Salem, Ohio home. (Emma Reed)
Kristina Muehlhauser has been a midwife for 37 years. She started midwifery in Connecticut, where she is from, and then traveled to Africa, where she lived for seven years with her family. She moved to New Salem, Ohio, 10 years ago and is now one of three midwives at a care clinic. As a midwife, Kristina is the family's point person for their pregnancy. She is the one who does all of the prenatal appointments and the birth - whether that be at home or at her care clinic.
Kristina spends much time traveling to families' homes for prenatal appointments, as most women are Amish and Mennonite and live in rural areas with little transportation. Kristina takes an average of three to five appointments daily and will not travel more than an hour to each appointment. Many deeply rural women will choose to drive to the care clinic for care due to Muehlhauser's inability to get to their homes. ​
Kristina Muehlhauser checks for an unborn offspring’s heartbeat during an appointment at an Amish client’s house who wishes to remain unnamed. (Emma Reed)
Muehlhauser's job differs from any other job; she is constantly on call. “We've been here ten years about… I've almost had no time off. But I love the job. So that helps I really love it.” She is one of the few who has not experienced significant burnout in her career. Ash Dasuqi was a practicing CPM but has since quit and teaches classes related to helping Queer individuals with birth, “There's not a midwifery support network to sustain the profession in this area at this time.”
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Women in rural Ohio rely on their midwives, especially in the maternity care deserts. For some women, a midwife is their only option. Prenatal care is a majority of what midwives do during
pregnancies, and it is one of the most vital parts of Pregnancy. Emily Neiman explains it, “We know that prenatal care and receiving early and regular prenatal care throughout your pregnancy really impacts maternal and fetal outcomes. So not being able to access regular care, maybe missing out on some of the screening, education, or testing that we do, could potentially impact people's health.”
Kristina has a rigorous schedule with the women she works with. She always has a physical calendar and schedules the next appointment on the day she is there. Prenatal appointments become more frequent as the due date approaches, so she wants the women to know when their next appointment is. ​​
(top) Valerie, a newborn baby, lays on her parent's bed as Kristina Muehlhauser, a 37-year certified professional midwife, takes her measurements after the homebirth of Megan Mascari at her home in Circleville, Ohio. (Emma Reed) (bottom left) Kristina Muehlhauser, takes the weight of Valerie, a newborn baby, with the help of Amber Tripp, a doula, during the home birth of Megan Mascari at her home in Circleville, Ohio. (Emma Reed)(bottom right) Megan Mascari holds her daughter, Rita Mascari, after giving birth to her other daughter, Valerie, at her home in Circleville, Ohio. Kristina helped Megan with Rita, her other daughter’s homebirth. (Emma Reed)
Kristina feels her job is very personal, so she does not take days off. “You just need to know that you can't say, well, today I just don't feel like it. I'm going to call in sick because those ladies are depending on you. It's not okay.I had home birth and it wouldn't have been okay if my midwife had said, I'm sorry. I have sick, kids, I can't come to you. It felt like life and death. And I knew that midwife and I needed her and it wasn't okay for her to say no.” The women who she helps rely on her to help them have a successful pregnancy.
(top left) Shiane, 2, tries to grab her little sister, Shaniah, 6 weeks, as Kristina Muehlhauser, a 37-year certified professional midwife, checks Shaniah’s heartbeat during her 6-week check-up at a client’s house. (Emma Reed) (top right) Kristina Muehlhauser with Dorthy, a pregnant Mennonite women, at her home near Ripley, Ohio. Dorthy’s daughter, Hailey, 3, walks through the frame. Kristina was Dorthy’s midwife for the birth of Dorthy. (Zoë Cranfill) (bottom) Kristina Muehlhauser, a 37-year certified professional midwife, embraces Shiane, 2, during a 6-week check-up at a client’s house. Kristina helped her client, Lorraine, 39, with her homebirths with Shiane and her newborn, Shaniah. (Emma Reed)
Women continue to come back to Kristina for all of their births because of the option of having a home birth. The women also appreciate Kristina's personal level to her job, unlike a doctor who may not see you as much. These women know Kristina is the one who will be delivering their babies. Kristina’s job does not stop after the birth of the child. She will not leave the
birth until she knows for sure that the mother and baby are safe; this could be hours after the birth. At six weeks, she will come and do a check-up on the baby and mother. She wants to ensure that the mother and child are healthy and safe. The level of care and ease of having a midwife is why many women have switched to this option in the past few years.
Lorraine, 39, a Mennonite mother, pats Shaniah, 6 weeks, her newborn’s back during her 6-week check-up with Kristina Muehlhauser, at her house. (Emma Reed)
The Vinton County OhioHealth Wellness on Wheels mobile health unit drives down a road in McArthur, Ohio, on Oct. 16, 2024. The Vinton County Wellness on Wheels mobile health unit recently did a soft launch outside of the Vinton County Health Department in late August to accept walk-ins but is not officially open to the public until 2025. (Emma Reed)
Wellness on Wheels
As maternity care access is lacking in rural areas around Ohio, healthcare providers are finding ways to bring care to counties with few resources nearby.
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OhioHealth started Wellness on Wheels mobile health units in 1993 to bring primary, prenatal, and maternity care access to residents throughout central Ohio who didn't have close access to hospitals or OB-GYNs. In partnership with March of Dimes, they brought nine mobile health units to areas around central Ohio, and OhioHealth plans to extend their services to the southeast region of Ohio. By January 2025, they plan to open mobile health units in Meigs, Noble, Perry, and Vinton counties, as they are considered maternity care deserts with no birthing hospitals/wards and OB-GYNs within those counties.
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Recently, OhioHealth started a soft launch for a mobile health unit in Vinton County by providing primary and maternity care to the residents in McArthur outside of the Vinton County Health Department. Suzanne Casa, the certified nurse midwife provider for the Vinton County mobile health unit, hopes to give back to the population.
“My hopes is that in the women’s health realm, the women here will have the same access to excellent care that women in Columbus will have.”
Suzanne Casa, certified nurse midwife from OhioHealth Vinton County mobile unit
of her hometown area as she started working for OhioHealth in 1985. Casa says, “My hopes is that in the women’s health realm, the women here will have the same access to excellent care that women in Columbus will have.”
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The mobile health unit is not officially open to the public but accepts walk-ins for any care needed in Vinton County. Tammi Mattey, a clinical nurse manager and the registered nurse at the OhioHealth Vinton County mobile unit says, “We want to keep care local. That’s one of the biggest things right now that Suzanna and I are working on is being able to keep these patients locally for their complete services. [We are working with the hospital and OBGYN offices so they know] what we do and who we are so that we can keep the patients here, not have to send them to Columbus for certain procedures and exams.”
A medical examination room is seen in the new OhioHealth Wellness on Wheels mobile health unit at the Vinton County Health Department in McArthur, Ohio.(Emma Reed)
An ultrasound machine and medical pamphlets sit in one of the examination rooms in the new OhioHealth Wellness on Wheels mobile health unit at the Vinton County Health Department in McArthur, Ohio. (Emma Reed)
Alycen Hannah, 2, plays with a toy as her mother, Ciara Scholderer, 27, fills out paperwork at the Athens County WIC Program in Athens, Ohio. (Emma Reed)
WIC- Women, Infants, and Children
Along with OhioHealth, Women, Infants & Children (WIC) is helping women who are pregnant, breastfeeding, postpartum, and children under five years old by being part of a nutrition program and providing unique nutritional needs to women and children in the southeast Ohio region.
In Ohio, there are WIC clinics located in all 88 counties. The WIC program was created in 1972 to help improve pregnancy outcomes for women and children. It provides nutrition education, breastfeeding education and support, supplemental foods and infant formula, and referral to prenatal, pediatric, maternal health care, and human services programs. Jill Flowers, a registered licensed dietitian, the Southeast Regional Rep for WIC, and the director of nutrition services at Hopewell Health Center, says, “At WIC, we’re helping women meet
unique nutritional needs. If the nutritional needs are met, health outcomes will be better, and we will play a more preventative role. We’re preventing or correcting nutrient deficiencies, then healthier moms, healthier babies.” Flowers also says WIC helps provide transportation services for women or children who need to travel far for their appointments and helps focus on the urgent maternal warning signs in women when they visit the center. Flowers says, “Some of the challenges are going to be just having providers in the county with transportation and economic constraints. If you’re looking specifically at young families, there’s a lot of stress. It’s not easy to pack up your kids and go. Sometimes, moms’ll get their children to their own well child check, but forget them getting back to their own.”
“Mortality rate in this country for women [who are] pregnant and postpartum is not what it should be considering the healthcare system that we have.”
Jill Flowers, a registered licensed dietitian, the Southeast Regional Rep for WIC, and the director of nutrition services at Hopewell Health Center
(left) Miret Mikhail, a registered dietitian at Athens County WIC Program, talks to Delilah Hawk’s mother, Makenzie Severt, 21, about her daughter’s vitals at the WIC examination room in Athens, Ohio.(Emma Reed) (top right) Miret Mikhail, a registered dietitian at Athens County WIC Program, puts a finger monitor on Delilah Hawk, 1, to check her vitals during her appointment at the WIC examination room in Athens, Ohio. (Emma Reed) (bottom right) Delilah Hawk, 1, plays with a toy while in the lobby of Athens County WIC Program in Athens, Ohio. (Emma Reed)
O'Bleness Hospital
O’Blenness Hospital in Athens, Ohio, is one of the leading hospitals where families travel to get care. The department is fully staffed with OBGYNs and a few Nurse Midwives. Due to O’Blenesse being so far from many people's homes and other issues, they tend not to make their prenatal appointments. The staff at O’Bleness saw this as an issue and are trying to create solutions. One of the OBGYNs on staff, Jane Broecker, explained, “Through some of the programs that we have with our family navigators here, we offer food boxes and diapers, and we have programs where when people come to their visits, they can receive some resources. That is going to enhance our adherence with recommended visit schedules.” Small acts like this make families more likely to make their appointments.
Another thing about O’Blenness that differs from other resources is that it is a one-stop-shop for everything. “We also have counseling available here. So in terms of helping people with postpartum depression, we have free counselors through a grant that we have through So this office, I think, does better in a rural area than other rural health care offices because we really bring services to this office so that if someone needs follow up for postpartum depression or would otherwise go to a food bank, we're a little bit more of a one stop shop. Pediatrics is right upstairs. So when somebody has their baby, if they're seeing the pediatric providers upstairs, they can see us for postpartum and take their baby upstairs for a weight check.” said Jane Broecker.
East 681 off of Route 33 near Darwin, Ohio in Meigs County. (Zoë Cranfill)